, Question 1
A patient presents with recurrent, unexpected panic attacks and persistent fear
of additional attacks. Which feature most reliably distinguishes panic disorder
from a substance-induced anxiety disorder?
A. Presence of nocturnal panic attacks
B. Temporal association between substance use and panic onset
C. Elevated cardiovascular reactivity on orthostatic testing
D. Co-occurring agoraphobic avoidance
Correct Answer: B - Temporal association between substance use
and panic onset
RATIONALE
DSM-5-TR requires that panic symptoms not be attributable to a
substance or another medical condition; a clear temporal link to
substance use indicates substance-induced anxiety. Nocturnal panic
and agoraphobia can occur in either condition, and cardiovascular
reactivity is nonspecific. Thus, the temporal association is the decisive
discriminator.
Question 2
Which neurobiological finding is most consistently associated with autism
spectrum disorder and supports its distinction from social (pragmatic)
communication disorder?
A. Reduced functional connectivity between the default mode network
and prefrontal cortex
B. Elevated striatal dopamine transporter density on PET imaging
C. Increased hippocampal volume on volumetric MRI
D. Enhanced gamma-aminobutyric acid (GABA) receptor binding in the
amygdala
Correct Answer: A - Reduced functional connectivity between the
default mode network and prefrontal cortex
Page 2
, RATIONALE
ASD is associated with atypical default mode network connectivity
and prefrontal dysconnectivity, which correlate with
social-communication deficits and restricted interests. Social
communication disorder lacks these consistent neural markers and
does not include restricted/repetitive behaviors. The other options are
not established discriminators.
Question 3
A patient with schizophrenia has been stable on clozapine for 2 years. Which
laboratory monitoring parameter is most critical to continue indefinitely to
prevent a life-threatening adverse effect?
A. Serum prolactin levels
B. Absolute neutrophil count
C. Liver function tests
D. Fasting lipid panel
Correct Answer: B - Absolute neutrophil count
RATIONALE
Clozapine carries the highest risk of agranulocytosis among
antipsychotics, requiring indefinite ANC monitoring per FDA REMS.
While metabolic and hepatic parameters are important, only ANC
monitoring is mandated to prevent a potentially fatal hematologic
emergency. Prolactin is not typically elevated with clozapine.
Question 4
Which statement best captures the DSM-5-TR approach to diagnosing
premenstrual dysphoric disorder (PMDD) in a patient with concurrent major
depressive disorder?
A. PMDD cannot be diagnosed if MDD is present.
B. PMDD requires prospective daily ratings of symptoms across at least
two symptomatic cycles.
Page 3
A patient presents with recurrent, unexpected panic attacks and persistent fear
of additional attacks. Which feature most reliably distinguishes panic disorder
from a substance-induced anxiety disorder?
A. Presence of nocturnal panic attacks
B. Temporal association between substance use and panic onset
C. Elevated cardiovascular reactivity on orthostatic testing
D. Co-occurring agoraphobic avoidance
Correct Answer: B - Temporal association between substance use
and panic onset
RATIONALE
DSM-5-TR requires that panic symptoms not be attributable to a
substance or another medical condition; a clear temporal link to
substance use indicates substance-induced anxiety. Nocturnal panic
and agoraphobia can occur in either condition, and cardiovascular
reactivity is nonspecific. Thus, the temporal association is the decisive
discriminator.
Question 2
Which neurobiological finding is most consistently associated with autism
spectrum disorder and supports its distinction from social (pragmatic)
communication disorder?
A. Reduced functional connectivity between the default mode network
and prefrontal cortex
B. Elevated striatal dopamine transporter density on PET imaging
C. Increased hippocampal volume on volumetric MRI
D. Enhanced gamma-aminobutyric acid (GABA) receptor binding in the
amygdala
Correct Answer: A - Reduced functional connectivity between the
default mode network and prefrontal cortex
Page 2
, RATIONALE
ASD is associated with atypical default mode network connectivity
and prefrontal dysconnectivity, which correlate with
social-communication deficits and restricted interests. Social
communication disorder lacks these consistent neural markers and
does not include restricted/repetitive behaviors. The other options are
not established discriminators.
Question 3
A patient with schizophrenia has been stable on clozapine for 2 years. Which
laboratory monitoring parameter is most critical to continue indefinitely to
prevent a life-threatening adverse effect?
A. Serum prolactin levels
B. Absolute neutrophil count
C. Liver function tests
D. Fasting lipid panel
Correct Answer: B - Absolute neutrophil count
RATIONALE
Clozapine carries the highest risk of agranulocytosis among
antipsychotics, requiring indefinite ANC monitoring per FDA REMS.
While metabolic and hepatic parameters are important, only ANC
monitoring is mandated to prevent a potentially fatal hematologic
emergency. Prolactin is not typically elevated with clozapine.
Question 4
Which statement best captures the DSM-5-TR approach to diagnosing
premenstrual dysphoric disorder (PMDD) in a patient with concurrent major
depressive disorder?
A. PMDD cannot be diagnosed if MDD is present.
B. PMDD requires prospective daily ratings of symptoms across at least
two symptomatic cycles.
Page 3
